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New Hampshire rates for HCPCS A5114

Leg strap; foam or fabric, replacement only, per set

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.58 / $5.58 / $6.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $5.58 / $7.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.09 / $6.09 / $6.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.95 / $7.51 / $7.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $6.38 / $8.58
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.67 / $8.67 / $26.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.54 / $5.30 / $6.54
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.16 / $7.88 / $10.02